Provider Demographics
NPI:1316401359
Name:ELECTROPHYSIOLOGIC TESTING AND PHYSICAL THERAPY SERVICES
Entity Type:Organization
Organization Name:ELECTROPHYSIOLOGIC TESTING AND PHYSICAL THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:TAMBURELLO
Authorized Official - Suffix:
Authorized Official - Credentials:PT, ECS, PHD
Authorized Official - Phone:757-424-7467
Mailing Address - Street 1:1601 MEETING HOUSE LN
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-7003
Mailing Address - Country:US
Mailing Address - Phone:757-424-7467
Mailing Address - Fax:
Practice Address - Street 1:725 VOLVO PKWY
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-1621
Practice Address - Country:US
Practice Address - Phone:757-252-4130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-23
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251E1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistElectrophysiology, ClinicalGroup - Single Specialty